Determine if Your Infant Has an Ear Infection

Ear infections are pretty common among babies, but it can still be a tough experience for both you and your infant. Luckily, we can help you be prepared by knowing what signs and symptoms to watch for so you can get your baby to their doctor and get the infection cleared up.

Steps

Recognizing the Common Symptoms

1. Be on the lookout for sudden ear pain. The hallmark symptom of a middle ear infection is a quick onset of ear pain due to fluid buildup from an inflammatory reaction. The pain will likely make your infant cry "out of the blue" with little warning of discomfort. The pain is usually worse when lying down, particularly when the infected ear is touching the pillow, so difficulty sleeping is to be expected also.
   • Try to have your infant sleep on his back with the head of the bed propped up so the ear pain is not exacerbated.
   • In addition to crying in response to the pain, your infant may also tug or pull at his ear — so be on the lookout for that as an indicator of discomfort.
2. Be suspicious if your baby is more irritable than usual. Aside from crying more, your infant may show other nonverbal signs of discomfort such as being fussy or irritable or showing signs of a cold. This irritable stage usually precedes the crying stage by a few hours and may coincide with waking up early from a nap or not being able to get to sleep to start with. As inflammation builds in the ear, a feeling of pressure or fullness increases, culminating in sharp, throbbing pain. Headaches are also common, which can compound an infant's discomfort and make her pretty unhappy about things — especially since she can't verbally communicate very well.
   • A middle ear infection is usually preceded by a sore throat, cold, or other upper respiratory issue (allergy). The infection or mucous is then transferred to the middle ear secondarily via the Eustachian tubes, which run from the ears to the back of the throat.
   • Some infants with an ear infection may vomit as well or even have diarrhea.
   • In addition to bacteria, viruses and allergic reactions to food (milk) and environmental triggers can also lead to infections that eventually spread to the middle ear.
3. Watch out for poor hearing or response to sounds. As the middle ear fills up with fluid and/or mucous, the ability to transmit sound is hampered. As a result, watch for signs of poor hearing, not being attentive, or not responding to loud sounds. Call your infant's name or clap your hands and see if he looks at you. If he doesn't, that could be a sign of an ear infection, particularly if he appears fussy or cranky.
   • In addition to temporarily reduced hearing, your infant may also appear to have a lack of normal balance. Structures in the inner ear are responsible for balance, so inflammation can affect their function. Pay attention to how your infant crawls or sits — if he leans to one side or falls over, that could indicate an ear infection.
   • Children get more ear infections compared to adults because their immune systems are not as developed and their Eustachian tubes are smaller and less inclined — making them susceptible to getting congested and no draining properly.
4. Check for a fever. Fevers are a sign that the body is trying to make it difficult for pathogenic microorganisms (bacteria, viruses, fungi) to reproduce and spread because most don't thrive in higher temperatures. As such, most fevers are beneficial, but they are a good indication that your infant is fighting something inside. Monitor your infant's temperature with a thermometer. A temperature of 100°F (37.7°C) or higher is typical for ear infections (and many other conditions too).
   • Avoid measuring your infant's temperature with an infrared ear thermometer if you suspect an ear infection. The build up of warm fluid (inflammation) in the inner ear heats up the eardrum and produces inaccurate readings that are too high. Instead, use a standard thermometer under the armpit or over the forehead, or use a rectal thermometer if you want to be very accurate.
   • Expect other typical signs and symptoms to accompany a fever such as loss of appetite, flushed skin (especially on the face), increased thirst, irritability.

Confirming with Your Doctor

1. Consult with your family physician or pediatrician. If you've noticed any of the above signs and symptoms lingering for a few days (and your parental instincts are tingling!), then make an appointment with the doctor. It's the best way to truly determine if your infant has an ear infection or any other condition that needs medical attention. Your doctor will use a lighted instrument called an otoscope to look at your infant's eardrum. A red, bulging eardrum indicates a middle ear infection.
   • Your doctor may also use a special pneumatic otoscope, which blows a puff of air into the outer ear canal against the eardrum. A normal eardrum moves back and forth in response to the air current, whereas an eardrum with fluid behind it doesn't move much, if at all.
   • A sign that an ear infection is likely more serious or advanced is if you observe a discharge of fluid, pus or blood from your infant's ear. In this case, you should consider bringing your child to an emergency clinic or urgent care clinic right away instead of waiting to schedule an appointment with your doctor. (Do check with your doctor first, as she may be able to see your child right away.)
2. Ask your doctor about the pros and cons of antibiotics. In actuality, most ear infections in infants/children resolve without any treatment, such as antibiotics. What's best for your infant depends on many factors, including her age and severity of symptoms. Childhood ear infections usually improve within the first couple of days and most clear up without antibiotics within one to two weeks. The American Academy of Pediatrics and American Academy of Family Physicians recommend a wait-and-see approach if: your infant over six months appears to have mild ear pain in one ear for less than 48 hours and a fever less than 102.2°F (39°C).
   • Amoxicillin is an antibiotic commonly prescribed to children with ear infections — it's meant to be taken over seven to 10 days.
   • Keep in mind that antibiotics are only helpful for bacterial infections and not viral or fungal infections, or allergic reactions.
   • The downside to antibiotics is that if they don't clear out the infection entirely; they can create resistant strains of bacteria that create even worse infections.
   • Antibiotics also kill the "good" bacteria of the GI tract, which can lead to digestive problems and diarrhea.
   • An alternative to antibiotics is medicated ear drops combined with small doses of acetaminophen given orally.
3. Get a referral to a specialist. You'll likely be referred to a specialist in ear, nose and throat conditions (otolaryngologist) if your infant's problem has persisted for some time, he is not responding to treatment, or the ear infection has occurred frequently. Most childhood ear infections don't cause long-term problems, but frequent or persistent infections can result in serious complications, such as impaired hearing, developmental delays (such as speech), widespread infection or tearing/perforation of the eardrum.
   • Torn or perforated eardrums can heal on their own, but occasionally require surgery.
   • If your infant has recurrent ear infections (three episodes in six months or four episodes within a year), the specialist may recommend a procedure (myringotomy) to drain fluid from the middle ear via a small tube.
   • Tubes stay in the ear drum to prevent further build up of fluid and ear infections. The tube usually falls out on it's own in about one year.
   • If placing tubes through the eardrum still doesn’t prevent ear infections, the otolaryngologist may consider removing the adenoids (they sit behind the nose and above the roof of the mouth) to prevent infection from spreading via the Eustachian tubes.

Tips

• Placing a warm, moist cloth over your infant's affected ear may lessen their pain or discomfort.
• Children cared for in group settings are more likely to get colds, and subsequently, ear infections because they're exposed to more childhood diseases.
• Babies who get bottle fed (especially while lying down) tend to have more ear infections than those who are breastfed.
• Childhood ear infections are more common during the fall and winter seasons when cold and flu viruses are more active/virulent.
• Avoid exposing your young child to cigarette smoke. Research has shown that infants who are around smokers have more ear infections.

Warning

• Do not attempt to diagnose your infant if you're not a healthcare professional. Being aware of the common signs and symptoms is great, but rely on your doctor for a diagnosis.

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